HEALTH SECTOR BULLETIN
March 2020 Libya Emergency type: complex emergency Reporting period: 01.03.2020 to 31.03.2020
Total population People affected People in need People in acute need 6.7 million 1.8 million 900,000 300,000 IDP Returnees Non-displaced Migrants Refugees 216,000 74,000 278,000 276,000 48,000 Target Health People in need Required Funded Coverage Sector Health Sector (US$ m) (US$ m) (%) 203,137 525,992 30 0 0
KEY ISSUES 2020 PMR (Periodic Monitoring Report) • Health sector does not have service delivery related indicators (February): coverage in the following districts: Nalut, Sirt, Number of medical procedures provided Tobruk, and Ubari. (including outpatient consultations, • There are only 40 PHC facilities which were referrals, mental health, trauma 18,845 assisted with no support in the following consultations, deliveries, physical districts: Al Jabal Al Akhdar, Aljufra, Almarj, rehabilitation) Azzawiya, Derna, Murzug, Nalut, Sebha, Sirt, Number of public health facilities Tobruk, Wadi Ashshati and Zwara. supported with health services and 53 • Situation with support of secondary health commodities Number of mobile medical teams/clinics facilities is of concern as only 13 hospitals 52 received assistance in Al Jabal Al Gharbi, (including EMT) Aljufra, Almargeb, Azzawiya, Ejdabia, Misrata, Number of health service providers and Wadia Ashshati and Zwara. CHW trained through capacity building 314 • Health sector does not reach any public health and refresher training facilities (PHC centers and hospitals) with Number of attacks on health care reported 1 Percentage of EWARN sentinel sites different types of support (services and 84% supplies) in Al Jabal Al Akhdar, Almarj, Derna, submitting reports in a timely manner Percentage of disease outbreaks responded Murzug, Nalut, Sebha, Sirt, and Tobruk). 80% • Most of health sector assistance was provided in to within 72 hours of identification 37 (37%) of 100 municipalities. Number of reporting organizations 10 • 14 (38%) of 29 reached municipalities were Percentage of reached districts 86% ranked as higher than 3 severity scale. Percentage of reached municipalities 37% Percentage of reached municipalities in • 8 confirmed cases of COVID-19 are reported in 38% Libya. Until present, a total of 120 cases were areas of severity scale higher than 3 tested for COVID-19 with 125 people on quarantine.
• Absence of holistic response to COVID-19. • Limited funding of health sector.
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HEALTH SECTOR BULLETIN March 2020
SITUATION OVERVIEW
• 10 March, Bani Waleed General Hospital announced the suspension of the hospital's ambulance and emergency departments following the security incident related to the extensive use of gunfire inside the hospital by unidentified group of people. • 12 March, A doctor affiliated to the Tajoura field hospital was killed, as a result of shooting on his car at the Garabolli coastal road. His companion was injured. • 14 March, Mr Sarraj, the Chairman of the Presidential Council of Libya and prime minister of the Government of National Accord (GNA) announced a state of emergency in Libya. • 15 March, INGOs’ common principles on humanitarian operations in the context of COVID-19 pandemic in Libya. • 18 March, 2020 - WHO strongly endorses UNSMIL’s appeal for a ceasefire in Libya to allow national health authorities and health partners to respond to the potential spread of COVID-19 in the country http://www.emro.who.int/lby/libya-news/unsmil-appeals-for-ceasefire-to-strengthen-covid-response.html • 22 March, Humanitarian Coordinator for Libya, Yacoub El Hillo, welcomes positive responses by Libyan parties to calls for a humanitarian pause and appeals for full facilitation of COVID-19 prevention and response efforts in Libya https://reliefweb.int/report/libya/humanitarian-coordinator-libya-yacoub-el-hillo-welcomes-positive- responses-libyan • 25 March, first confirmed COVID-19 case reported in Libya. • 26 March, the Libya INGO Forum members commit to support the country to cope with the COVID-19 pandemic and call on the authorities for equal and fair access to medical services for all people in Libya. • Tripoli/Tunis, March 26th, 2020 • 27 March, An attack targeting of an ambulance point in the Abu Qurayn area near Sirte. The attack resulted in the injury of two paramedics and destroyed an ambulance. • 27 March, Statement by the WHO Regional Director Dr Ahmed Al-Mandhari on COVID-19 in the Eastern Mediterranean Region • 27 March, A public letter from the Ambassador of the United States to Libya, Richard Norland, to Libya’s political and military leadership and the people of Libya. • 28 March, additional set of precautionary COVID-19 measures is introduced, including increase of the curfew time to be from 2pm until 7am. • 30 March, 8 confirmed cases of COVID-19 are reported in Libya. Until present, a total of 120 cases were tested for COVID-19 with 125 people on quarantine. • 30 March, Ambassador Norland, joined by U.S. Department of the Treasury Deputy Assistant Secretary Eric Meyer, spoke with Finance Minister to underscore U.S. support as Libyan economic institutions and decision makers attempt to come together to COVID-19 pandemic. Ensuring the timely distribution of public sector wages and prompt allocation of funding for the National Center for Disease Control (NCDC), municipalities, and other Libyan stakeholders to prevent the spread of and respond to COVID-19, are vital to promote the health of all Libyans.
PUBLIC HEALTH RISKS, PRIORITIES, NEEDS AND GAPS:
Gaps and weaknesses of health sector response (based on 4W February analysis)
Strategic objective 1: Increase access to life-saving and life-sustaining humanitarian health assistance, with an emphasis on the most vulnerable and on improving the early detection of and response to disease outbreaks.
Provide a minimum package of integrated health services at primary and secondary levels (integrated services cover emergency and trauma care, management of Communicable and Non-Communicable Diseases, Maternal, Neonatal and Child Health (MNCH), Mental Health and Psychosocial Support (MHPSS) and clinical rehabilitation).
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• Health sector does not have service delivery coverage in the following districts: Nalut, Sirt, Tobruk, and Ubari. No service provision was registered in terms of support with outpatient consultations, referrals, trauma/injury related, mental health and disability related consultations, vaginal and caesarian support. • Number of outpatient support is at minimum in Al Jufra, Al Jabal Al Akhdar, Almarj, Derna, Murzug, and Wadi Ashshati. • No trauma response is provided in Al Jabal Al Akhdar, Almarj, Derna, Ejdabia, Ghat, Murzug, Nalut, Sirt, Tobruk, Ubari, Wadi Ashshati, Zwara. • Referral system should be enhanced in Al Jabal Al Akhdar, Al Jufra, Al Margeb, Almarj, Ejdabia, Ghat, Murzug, Nalut, Sebha, Sirt, Tobruk, Ubari and Wadi Ashati. No referral services are available in these districts. • Mental health consultations are not provided in most of districts (with the exception of Al Jabal Al Gharbi, Misrata, Sebha, and Tripoli). • No response on disability support. • Reproductive Health services are not being reported (support to vaginal deliveries and caesarian sections).
Provide continuous and interrupted immunization services to children
• There is no data available or shared by the authorities for coverage by Hexa and/or MMR.
Expand the reporting capacity of the early warning system and support health authorities to carryout timely response to disease outbreaks
• There is a need to scale up and increase not only the number of new sentinel in different districts but make sure the current ones (126) are all active while 84% provide regular reports.
Strategic objective 2: Strengthen health system capacity to provide the minimum health service package and manage the health information system.
Coordinate the humanitarian health response
• There are no reported assessments by any organizations.
Provide health facilities with essential medicines, medical supplies and equipment
• There are only 40 PHC facilities which were assisted with no support in the following districts: Al Jabal Al Akhdar, Aljufra, Almarj, Azzawiya, Derna, Murzug, Nalut, Sebha, Sirt, Tobruk, Wadi Ashshati and Zwara. • Situation with support of secondary health facilities is of concern as only 13 hospitals received assistance in Al Jabal Al Gharbi, Aljufra, Almargeb, Azzawiya, Ejdabia, Misrata, Wadia Ashshati and Zwara. • Response with assistance with medical equipment is nonexistent or not being reported properly. Only 1 piece of medical equipment is being reported to be donated in Al Jabal Al Gharbi. • Standard health kits were only provided in Ejdabia, Misrata, Tripoli, Ubari, Wadi Ascshati and Zwara districts.
Increase access to health services by establishing functional health facilities and mobile medical teams (including EMT)
• Minimum response is in place with rehabilitation/refurbishment of health facilities as only 2 health facilities were supported (Aljafra and Almargeb).
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• It is essential to receive a standard list of camps and settlements in order to evaluate the impact and coverage of these locations by mobile medical teams and fixed health clinics.
Health sector does not reach any public health facilities (PHC centers and hospitals) with different types of support (services and supplies) in Al Jabal Al Akhdar, Almarj, Derna, Murzug, Nalut, Sebha, Sirt, and Tobruk)
Strategic objective 3: Strengthen health and community (including IDP, migrants and refugees) resilience to absorb and respond to shocks with an emphasis on protection to ensure equitable access to quality health care services.
• Capacity building events covered 314 health service providers with coverage only in Aljfara, Almargeb, Benghazi and Tripoli. • The highest number of covered health workers by trainings is in Tripoli (194). • No training courses targeting community health workers were reported. • No health workers were trained on CMR (clinical management of rape).
COVID-19
WHO has defined four transmission scenarios for COVID-19:
1. Countries with no cases (No cases) 2. Countries with 1 or more cases, imported or locally detected (Sporadic cases) 3. Countries experiencing cases clusters in time, geographic location and/or common exposure (Clusters of cases) 4. Countries experiencing larger outbreaks of local transmission (Community transmission).
Libya is currently in scenario 3.
Current gaps
There is a national plan from NCDC costed at 10.5 million LYD which has not been funded. There a statement from the PM in Tripoli allocating 350 million LYD which has not been funded or expected to transliterate into the actual channelling of funds as there is no plan, transfer modality behind this allocation.
Available NCDC plan cover key pillars under its technical domain with the exception of very important one: “case management”. This needs to be done by the MoH. Both Ministries of Health in the East and West face a number of challenges disabling them to provide a holistic and comprehensive approach with collection and consolidation of their needs.
There is no source of information and reference point among any of the authorities who will respond to the question of isolation and quarantine structures, ICU beds, respirators, staff per governorate/ location & critical gaps and initiative to fill those gaps. It is essential to understand that since the last 1.5 months information about public hospitals assigned with isolation wards and hospitalization of highly suspected cases or confirmed patients was changing on a daily basis. Names and locations of assigned hospitals have been changing on a daily/weekly basis linked with the refusals from community; refusals from the armed groups in charge of specific areas; the refusals from health workers themselves. The focus of national authorities has been shifted to consider military health installations for this purpose while no clarity on facilities in the east and south.
Information of a country nation-wide analysis of current local market capacity assessment, scalability of national and external response is available as there is no national response.
There is no way at this stage to predict and find solutions for fast track procedures for supplies, as despite all high level advocacy in the last 3 months, the officials simply do not recognize the essentiality of this kind of work behind
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international organizations while applying regulations of “private sector” compliance to the humanitarian organizations.
While expecting health sector partners to target traditionally labelled “crisis-affected communities”, specific prioritized geographical areas, the following should be noted: There are4 scenarios of response. Health sector responds to the needs and cover gaps based on the reality on the ground which is: the South is absolutely not prepared or capacitated to response; the East has very limited capacity with preparedness only carried for Benghazi city neglecting all other areas; the West has the highest population concentration. It must be taken into consideration that from health sector severity scale all 22 districts were classified as 3 and 4 in needs and acute needs (from 0 to 5). Considering the situation with PoEs the virus will affect any of geographical areas and this is again in the situation of absolute unpreparedness with different municipalities finding “local solutions” to the best of their knowledge.
The reality is that municipalities being left on their own to find operational solutions and solely dependent of central funding which is not there. So far there are no indications of this. Therefore, we as health sector push for planning and response at a municipality level leaving it up to each interested health sector stakeholder to carry out the following at a respective municipality level: to assess, to buy, to equip and to train.
There is clear disconnect between Tripoli and Benghazi level’ authorities of the actual needs at municipality levels. The data, information related to the needs and gaps and key asks from various municipalities are not being aggregated at the central levels while there is a pressure on international organizations to channel their planning and response options solely through the central based authorities before taking any response action down on the ground at a municipality level.
In this situation each health sector organization literally becomes and will stand as a provider of last resort having to be directly engaged in responding to the gaps and needs in multiple directions under all 8 recognized pillars.
Health sector does not have time to wait as the response should have taken place “yesterday”. The sector has to act on its best projections, guestimates, with all understanding of systemic challenges within the national authorities (not only between the east and west but within competing internal interests and conflicts within various official structures). In this situation health sector does not have to wait any longer but to take a decision to commit to support across the country (within the operational domain of each health sector partner), with the prognosis of operational flexibility to shift possible assistance/response if and when needed depending on the transmission of the disease.
Key operational asks:
• OCHA – to ensure representation of inter-sector planning and response at the existing high level (inter-ministerial) task forces in Tripoli and Benghazi with the main goal to align international response with national one. • OCHA – to initiate and consider civil military cooperation options with different armed groups. • OCHA – to propose best inter-agency and inter-sector global and regional supply chain practices and capacity support to the national authorities to effectively and efficiently utilize announced 500 million LYD package of assistance. • OCHA – to rationalize quantities of coordination meetings chaired (e.g. ISCG, HCG, COG, HCT). • Authorities – to enable provision of actual funding by the Libyan authorities to the NCDC response plan and support MoH hospitals and municipalities. • Authorities – to immediately provide exemptions from imposed curfews for staff of organizations working to support the national efforts (for mobile medical teams for contact tracing and follow up, but also for non-medical teams providing essential services) especially in those geographical areas with confirmed cases. If no immediate solution is found, medical agencies will have to step out from the plan.
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• Authorities – to include representatives of international organizations into the structure of COVID-19 emergency committees established • Authorities – to remove all restrictions and allow importation of any health supplies related to COVID-19 response (medicines, consumables and equipment) and non COVID-19, as shortages of essential medicines impact put more strain on the health system and capacity of humanitarian agencies, and thus have repercussions of the ability to respond to COVID-19 pandemic. • Authorities – to immediately facilitate a process of issuing visas for international staff and technical experts to get engaged with COVID preparedness and response. If no immediate solution is found, medical agencies will have to step out from the plan. • Authorities – to develop and update the lists of needs (of different ministries) for COVID-19 preparedness and response and communicate regularly to the international community through OCHA.
Lifting restrictions or fast track on importation of health supplies: One of the key immediate operational asks is to request national authorities to remove all restrictions and allow importation of any health supplies related to and beyond COVID-19 response (essential medicines, consumables and equipment).
In order to be factual and concrete in the dialogue with the authorities at all levels in Tripoli and Benghazi, health sector is requested to provide the relevant feedback on the health supplies subjected to different clearance and approvals in: 1) Different seaports; 2) Different airports; 3) Pipeline; 4) Planned
The first update will be available on 1 April to inform DSRSG, WHO and OCHA accordingly to take further advocacy steps.
Detention centers and prisons
Continued advocacy for ensuring access to diagnostic, treatment and follow for migrants, refugees, people detained in “formal” and “informal” detention centers and prisons:
Advocacy continues, with some encouraging results (Libya's Public Prosecution has ordered the release of 466 prisoners as part of precautionary measures against the outbreak of Coronavirus, Ministry of Justice of the Government of National Accord), to decongest the detention centers where about 1500 migrants, refugees and asylum seekers are currently detained through the expedited release of women, children, the sick and the elderly, plus allowing those disembarked after interception/rescue at the sea to go back to the communities and not be taken to detention centers. o Access and Inclusion: All populations must be included in surveillance, preparedness, response plans and activities. o Release from Detention: The current crisis requires reduction of crowding and decongestion everywhere in the country, including in detention centers. o Release of Disembarked Migrants and Refugees: In order to reduce crowding and risks of COVID-19, disembarked individuals should not be confined in detention centers or investigation units but should be released in conditions that will allow them to undertake appropriate preparedness and prevention steps.
Key considerations:
• Enhanced coordination is required between the Ministry of Interior, Ministry of Health and Ministry of Justice. • Operational health organizations inside the detention centers are to facilitate a dialogue between the administration of detention centers and NCDC to enable timely access for laboratory teams to visit a DC for taking samples from any suspected case. • Administration of detention centers should be advised by the operational health organizations to allocate and assign an isolation place for any suspected case pending of lab results. • For any confirmed case among migrants and refugees an additional high level advocacy from the side of engaged operational health sector organizations with health authorities will be expected to ensure timely hospitalization to any of COVID-19 hospitals.
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Protection, dignity and promotion of the rights of Women and Girls
Health sector emphasizes on the protection, dignity and promotion of the rights of Women and Girls. The existing protection and gender inequalities could be further compounded and the risk of Gender based violence, sexual exploitation and domestic violence will increase due to house confinements. Provision of sexual, reproductive health (SRH) care, family planning and other SRH commodities, including menstrual health items, are central to women’s health, empowerment, and development and is already impacted supply chain due to ongoing conflict could further undergo strains from COVID 19 pandemic response.
Enabling allocation of national funds to COVID-19 response
Overview of UNCT response was prepared and shared with the Libyan Ministry of Foreign Affairs by the DSRSG, Mr Yacoub El Hillo.
WHO Libya have advocated for the US Ambassador to Libya, Mr Norland to put pressure on the Ministry of Finance and the Head of the Central Bank in order for Libya’s own resources to be released to respond to the COVID-19 crisis. At the request of WHO, Mr Norland raised an additional essential point in his public letter ” I am concerned that critical medical supplies procured by the WHO – including COVID-19 testing elements, protective equipment, antibiotics, and insulin – are stuck in ports in Tripoli, Misrata and Benghazi, due to delays from Libya’s Customs and Food & Drug Authorities. I call on relevant authorities to immediately release these supplies”.
At the request of WHO Libya, the SRSG a.i., Ms Stephanie Williams contacted the Prime Minister, the Minister of Finance and the Head of the Central Bank to insist that health care workers’ salaries be paid (their salaries had not been paid since December 2019). The Head of the Central Bank pledged to put a priority on all funding to respond to the pandemic. The Minister of Finance promised to promptly release funds to fund the National Preparedness and Response.
On 30 March it was announced that 75 million LYD would be allocated to all municipalities across the country.
Libya is a middle income country which gains approximately USD 60-70 million per day on its oil resources and has an enormous amount of frozen assets in banks abroad. The role of WHO as health sector lead is therefore not to cover their health expenses, but to advocate for an adequate amount of Libya’s GDP and part of its huge assets to be spent on health.
HEALTH SECTOR ACTION/RESPONSE
Health sector response (based on 4W February analysis):
• 10 health sector organizations are operational (5 UN agencies: UNFPA, IOM, UNHCR, WHO, UNICEF; 5 INGOs: IRC, GIZ, IMC, PUI, TdH) • 19 (86%) out of 22 districts were reached by health sector partners. • Most of health sector assistance was provided in 37 (37%) of 100 municipalities. • 14 (38%) of 29 reached municipalities were ranked as higher than 3 severity scale. o 798 (100%) of medical procedures (HRP funded) took place in areas higher than 3. o 6,156 (53%) of medical procedures (HRP funded) and 5,358 (47%) of
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medical procedures (non HRP funded) took place in areas ranked as 3. o 6,040 (92%) of medical procedures (HRP funded) and 502 (non HRP funded) took place in areas ranked less than 3. • A total of 18,584 medical procedures (including 16,977 outpatient consultations, 371 referrals and 1,366 trauma related consultations,183 mental health consultations, 1 disability related consultations) were provided by health sector organizations. There is a need to improve reporting by health sector organizations clearly identifying the type and quantity of services covered. It is believed that the actual number of medical procedures is higher in the reality. • 61% of all medical procedures were provided in severity scale less than 3 while 4% in areas ranked as 3 and 35% in areas higher than 3. There is a need for health sector partners to include more areas of severity scale higher than 3 in their respective planning and response. • The gender breakdown of patients who received medical procedures: 51% - men, 49% - women. 19% of services were for children younger than 18 years old while 81% of services to adult population (older than 18%). • 49 health facilities and community center provide MHPSS services. • 52 mobile medical teams/clinics are deployed across the country, including 38 covering areas of severity scale 3 areas and 10 in areas higher than 3. • 63 health facilities (including detention centers, collective centers, and community centers) are supported by mobile medical teams/clinics across the country. Out of 63 health facilities, 52 are located in severity scale 3 areas, 9 – in higher than 3 and 2 – in less than 3 severity scale areas. • 84% of EWARN sentinel sites report in a timely manner with 80% of disease outbreaks responded to within 72 hours of identification. • There are 126 EWARN sentinel sites across the country with the highest concentration of them in Al Margeb, Benghazi, Eljdabia, Misrata, and Zwara. • 40 public PHC centers received support with health services and commodities. • 13 public secondary health facilities received support with health services and commodities. • 2 public health facilities received support with physical rehabilitation/refurbished. • A total of 18 standard health kits were distributed. • 1 health facility received support with medical equipment. • Health sector partners cover 7 IDP camps in Benghazi, Misrata and Tripoli. • 9 official detention centers in Al Jabal Al Akhdar, Azzawya, Eljdabia and Tripoli are covered by fixed health points and/or mobile medical teams. • 9 disembarkation points are covered by fixed health points and/or mobile medical teams. • 53 public health facilities (PHC centers and hospitals) are supported some kind of assistance including services and supplies. • A total of 314 health service providers were trained. • 1 flash update on attack on health care was produced.
Needs assessments:
GIZ informed about the results of health needs assessment conducted in collaboration with International Medical Corps (IMC) and Proximity International (PI) at the onset of the Libyan-German PHC Project in 2019. The assessment consisted of three Phases: (I) Broader PHC needs assessment in sixteen municipalities; (II) Detailed PHC capacity assessment in eight municipalities; and (III) Expert evaluation of five PHC centers (PHCCs).
WHO Libya is launching health assessment at a community level. The assessment will be carried in 100 selected communities across the country.
Capacity building support:
Overview of health sector training courses/workshops with Libyan health and non-health workers for March and April is updated and available upon request.
Bi-weekly operational update (1-15 March)
Bi-weekly operational update was consolidated and disseminated.
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COVID 19 response:
Pillar 1: Coordination:
National authorities’ update:
• High level inter-ministerial task force was formed after the declaration of the state of emergency on 14 March in Tripoli chaired by the PM. • Emergency Technical Group meetings led by the Minister of Health are held daily. • In the east of the country a Supreme Committee was established comprised of representatives of line ministries and Medical Advisory Committee on 16 March. • In the south WHO was requested to take the lead to coordinate the preparedness and response levels in close coordination with NCDC branch Sabha. • WHO team conducts almost daily regular technical and coordination meetings with NCDC. • Ongoing bi-lateral briefings between WHO and different Member States. • General Authority for Awqaf and Islamic Affairs disseminated regulation on COVID-19 • The NCDC carries out sensitization workshops for other line ministries. The NCDC works closely with the Ministry of Interior and Ministry of Defense.
Health sector response:
Regular health sector situation updates are being produced and published.
Ad hoc health sector meetings are being conducted on a regular basis.
Health Sector Coordination Meeting on COVID-19 took place on 5 March in Tripoli with participation of MoH, NCDC, UNICEF, WHO, UNFPA, IOM, IMC, MSF-H, UNHCR, GIZ, ODP, and IRC.
Mapping of available resources to assist with COVID-19 response in Libya, 25 March (IMC, MSF-Holland, MSF-France, IRC, CEFA, WFP, Emergency Telecom Sector, UNICEF, IOM, UNFPA, UNHCR, UN Women, UNODC, WHO) was completed. Inputs related to UNCT Libya were shared with MoFA in Tripoli.
Participates in inter-sector COVID 19 Operational Group (COG) led by OCHA and briefs a group of Country Directors of 20 INGOs in Libya.
Health sector (COVID-19) preparedness and response plan for Libya is finalized based on the inputs of WHO, IOM, UNHCR, UNICEF, UNFPA, UN Habitat, IMC, HI, TDH, MSF-Holland, MSF-France, Emergenza Sorrissi/Naduk, IRC, and PUI.
Estimated funding requirements (by organizations) TOTAL (USD) Funding Available (USD) Funding Gap (USD) WHO 3,265,000 565,000 2,700,000 UNFPA 1,215,800 0 1,215,800 UNICEF 1,827,000 0 1,827,000 UNHCR 600,000 0 600,000 IOM 2,440,000 376,300 2,063,700 UN Habitat 260,000 0 260,000 TDH 555,000 0 555,000 IMC 414,000 279,000 135,000
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Emergenza Sorrisi/Naduk 697,000 45,000 652,000 HI 350,000 350,000 0 IRC 450,000 450,000 0 PUI 430,000 0 430,000 TOTAL: 12,503,800 2,065,300 10,438,500
Current mapping of proposed response coverage by international organizations
District/Mantika Present health sector organizations Al Jabal Al Akhdar WHO, UNICEF Al Jabal Al Gharbi WHO, UNICEF, TDH Aljfara WHO, UNICEF, IMC Aljufra WHO, Alkufra WHO, UNICEF, IOM, PUI Almargeb WHO, UNICEF Almarj WHO, Azzawya WHO, UNICEF, IOM, Emergenza Sorrisi/Naduk, TDH, IMC Benghazi WHO, UNFPA, UNICEF, IOM, IMC, HI, PUI, UNHCR Derna WHO, Ejdabia WHO, UNICEF Ghat WHO, UNFPA, UNICEF, IRC WHO, UNFPA, UNICEF, IOM, Emergenza Sorrisi/Naduk, TDH, IMC, MSF-France, HI, IRC, Cesvi, Misrata UNHCR Murzuq WHO, UNICEF, Nalut WHO, TDH, IMC Sebha WHO, UNFPA, UNICEF, IOM, TDH, IMC Sirt WHO, TDH Tobruk WHO, UNICEF Tripoli WHO, MSF-Holland, UNFPA, IOM, Emergenza Sorrisi/Naduk, TDH, IMC, HI, IRC, UNHCR Ubari WHO, UNICEF, TDH, IRC Wadi Ashshati WHO, UNICEF Zwara WHO, UNICEF, IOM, TDH, MSF-France
WHO continues to provide technical support to the NCDC and MoH on all 8 pillars of priority response.
Pillar 2: Risk communication and community engagement
National authorities’ update:
• The NCDC communicate, regularly and transparently with the population regarding the COVID-19. Timely disseminate information and messages targeting different audiences, using different communication channels (social media, TV channels, NCDC health media, and phone calls). • The NCDC designed and printed posters and leaflets to increase public awareness. • All interested organizations should fully utilize the available health education and awareness materials produced by NCDC and MoH Libya.
The following pages are active and regularly updated:
• https://www.facebook.com/NCDC.LY/; • https://www.facebook.com/Ministry.of.Health.Ly/; • https://covid19.ly/
Health sector response:
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Risk Communication and Community engagement group-led by NCDC and UNICEF as co-lead-jointly with WHO, UNFPA and IOM has been activated. An integrated communication strategy has been developed and will be discussed with key partners soon to delineate roles and responsibilities of all and develop implementation plan.
Community engagement working group was established.
WHO printed 100,000 leaflets for further distribution with WFP food baskets. In addition, WHO re-printed 5 different types of NCDC produced information materials (25,000 copies).
WHO continues a series of constant awareness and educational activities across the country through the network of 10 field coordinators and hubs in Benghazi and Sabha.
UNICEF provided support to print out 50,000 IEC materials (flyers and posters) produced by NCDC, including production of real and animated videos on COVID prevention.
Pillar 3: Surveillance, rapid response teams and case investigation
National authorities’ update:
• Earlier 6 RRTs were formed by NCDC for points of entry (PoE) - Tobruk, Benghazi, Misrata, Tripoli, Zwara and Sabha. • 60 surveillance teams of NCDC (3 people per 1 team) are planned to be utilized for COVID-19 response but a series of operational actions must be put in place immediately to activate these teams. • A separate joint mission to the south is planned with objectives to build up capacity of NCDC branch in Sabha.
Health sector response:
• Technical and operational support (WHO, UNICEF, IOM, IMC, IRC, MSF-H) is being provided for contact tracing and development of the work plan for the RRT across the country. • IMC supported the NCDC with 100 gowns, 5000 examination gloves, 100 goggles, 5000 masks, 10000 aprons, 200 masks N95, 30 gum boots and 50 heavy duty gloves. • WHO procured locally and ready to distribute 17,000 examination gloves, 15,000 sterile gloves, 3,000 sterile gowns, 15,000 gowns, 4,000 surgical masks, 10,000 aprons, 10,000 surgical caps and 150 hand disinfecting gels. • Following confirmed cases in Misrata WHO repurposed one of its mobile team in Misrata to coordinate and support NCDC Misrata branch in contact tracing of COVID 19 cases. • UNHCR is working closely with the authorities (Ministry of Health and Ministry of Interior) and interested agencies (WHO, UNICEF, IOM) to repurpose the infrastructure of the emptied GDF (Gather and Departure Facility) in Tripoli as part of COVID-19 preparedness. Decisions and commitment is necessary from the national authorities to agree to utilize this premises for quarantine purpose.
Pillar 4: Point of entry
National authorities’ update
• Points of entry (PoEs) to screen travelers arriving from affected areas have been established at three airports (Mitiga, Misrata and Benina), four sea ports and border entry points at Ras Jdder, Wazen and Msaed. Each PoE is coordinating with the NCDC’s International Health Control Office on the measures to be taken to detect suspected cases. Supervisory field visits take
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place on a regular basis. • Further clarity is required on the status quo of all points of entry across the country, especially considering the news and information that there is an active use of international military cargo being brought into the country while no information is available on COVID-19 compliance and regulations in place there. There is high level of risk. • There is information that border crossing points between Tunisia, Egypt and Libya (including airports) are not fully closed down with more than 6,000 people returning to Libya with no required checks after the declaration of state of emergency. • There is no information on the actual number of PoE across the country (that used to be functioning and non- functioning).
Health sector response:
IOM informed about deployment and establishing health offices in 2 border crossing points (Tunis and Egypt) and 5 disembarkation points.
Pillar 5: National laboratory
National authorities’ update:
• The national laboratory in Tripoli has been made ready to receive and test COVID-19. Similar arrangements were made for Benghazi. There are plans to expand to three other cities (Zwara, Misrata and Sabha). It is essential to consider all options to expand lab capacity across the country. • 8 PCR kits were procured by NCDC with 1 donated by a private organization. • Options are being looked at the use of earlier donated Gene Expert machines for COVID-19 diagnostic.
Health sector’ update:
WHO dispatched 1 set of PPE to NCDC and delivered 1 PCR kit (100 tests) for diagnostic of COVID to Tripoli and Benghazi and supported NCDC logistically for 3 PCR kits imported from Germany.
WHO continues to meet with the high-level authorities in Benghazi to facilitate the transportation of COVID-19 reagents between Tripoli and Benghazi.
UNDP plans to procure 54,000 tests as requested by the NCDC.
Pillar 6: Infection prevention and control
National authorities’ update:
See the section below on capacity building events.
Health sector’ update:
See the section below on capacity building events.
WHO supports NCDC and MoH preparedness measures and to provide WHO guidelines and last updates.
Pillar 7: Case management
National authorities’ update:
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• Preparedness and response remains very low and chaotic with absence of organized and controlled approach. • Earlier made announcement to assign 5 hospitals for COVID-19 response (2 in Tripoli, 1 in Misrata, 1 in Nalut and 1 in Benghazi) was not operationalized. • In Tripoli – Tripoli Medical Center (or Tripoli University Hospital) and Tripoli Central Hospital were initially assigned for COVID-19 patients. Then information about Al Khadra teaching hospital was received as well as about the building of the ophthalmology hospital. • In Tripoli one of the key armed groups is reported to be engaged in preparedness with completing rehabilitation and establishment of two out of three isolation sites in the area of Mitiga international airport (the location of Mitiga military hospital). • Earlier the Ministry of Health in Tripoli announced that it has prepared 16 health isolation sites outside hospitals and is preparing 500 beds for intensive care units. Locations have not been shared with the health sector. • Rehabilitation activities continue to prepare isolation sites in Zwara, Ghadames, Zliten and Tripoli. Further clarity is required on the nature (military related) of the areas of location of these isolation sites. • LNA is reportedly established 4 field hospitals for COVID-19 within the military supported sites. • LNA authorities report opening a new isolation ward in Al Hawari general hospital in Benghazi (134 bed capacity, including 34 ICU beds equipped with ventilators, monitors, etc.) • There are reports for Tripoli MoH authorities to establish a field hospital (1500 bed capacity!) in Tajoura municipality with possible UNDP support. • There were reports that 50 ambulances belonging to military health services were loaded with essential health supplies to reach to different municipalities under Tripoli control. The information is being cross checked. • It is reported that 56 containers (40 feet) containing essential health supplies and consumables which can be used for COVID-19 and procured earlier through MSO (Medical Supply Office) got finally released by the customs. • Information was shared that air cargo Boeing 747 delivered PPE to Tripoli. • LNA authorities procured 65 ambulances with the distribution across the areas.
Health sector’ update:
WHO works on collection of data and information on readiness and preparation mapping at a district and municipality level. Three WHO hubs and 10 field coordinators are involved in this process.
Pillar 8: Operational support and logistics
Different agencies and organizations continue to receive various requests for support from municipalities and other entities. It is recommended to channel these requests to the health sector coordinator for the necessary follow up and coordination with health sector organizations and national authorities.
At this stage lists of needs were received from: National authorities in Tripoli; the South Emergency Committee; Al Kufra; Al Khoms; Arrayayna; Bent Baya; Misrata; Algurdha Ashshati; health office of Ras Ijder land border and disseminated accordingly to the health sector and interested donors.
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Coordination of COVID-19 capacity building
The latest update of COVID-19 related training courses/workshops with Libyan health and non-health workers, 31 March 2020 indicates that almost 70 events are and will be supported jointly by UNICEF, UNFPA, IOM, IMC, IRC, MSF-H, MSF-F and WHO in March-April 2020 across the country on key subjects.
• UNICEF – 2 events • UNFPA – 6 events • IOM – 2 events • IRC – 2 events • IMC – 11 events • MSF-H – 7 events • MSF-F – 9 events • WHO – 32 events
WHO leads the process on the standardization of training package for Libya with coordination with MoH, NCDC and health sector partners.
UPDATES FROM PARTNERS
UNHCR donated 4 ambulances to four medical facilities in the south of Libya with a view to supporting the Libyan health sector, targeting the facilities most in need of assistance in these times of hardship. Representatives from the Health Departments of Derej Municipality, Sebha Medical Center, Brak Alshati Municipality and Ghat municipality attended a handover ceremony and a meeting with the UNHCR Assistant Chief of Mission for Protection, Ms. Areti Sianni, to further discuss the needs of the different municipalities in terms of medical equipment, in addition to the preventive measures being taken in response to COVID-19 pandemic. UNHCR will keep assessing the needs of different municipalities across the country and will continue its support in solidarity with the Libyan population at this moment of need.
IOM provided 2163 medical consultations to migrants and IDPs including responding to emergency cases, referral to secondary and tertiary health care facilities, conducted regular medical visits and follow ups in different locations all over Libya (Dahr Aljabal DC, Tariq Al-Sikka DC, Al-Sabaa DC, Janzour DC, Shouhada Alnasr DC, Abu Issa DC, Ganfouda DC, Tokra DC, Kufra DC, Souq Alkhoums, Alawaineya and 17 Feb PHC centers).
636 medical consultation were provided using mobile clinics targeted urban locations in Tripoli, including Surbana Shelter (Hai Alandalus), Sudanese Shelter (Souq Aljumaa) and Abousalim Shelter. IOM established the Migrant Resource and Response Mechanism (MRRM) program along the migratory route in Zwara, Sabha, Qatroun, Tripoli, Hay Alandalus Office and Bani Waleed with 1254 medical consultations provided to migrants living in urban areas as well as vulnerable cases from the host community. IOM MHD gynecologist and obstetrician provided antenatal follow ups to 22 pregnant ladies. IOM doctors responded to 86 emergencies medical and surgical cases with referral to secondary and tertiary health care facilities. IOM MHD Psychiatrist provided medical consultations to 20 migrants.
IOM medical team responded to rescue at sea operations where 230 migrants were rescued with conducted triage. IOM continues its support to the MoH and municipalities: procured and donated equipped mobile clinic to Janzour
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municipality. IOM teams conducted active TB screening campaign in collaboration with the NCDC team in Dahr Aljabal, Shouhada Alnasr, Abu Issa Subrata) for screened detainees (908 - by x-ray and123 by sputum).
The International Rescue Committee (IRC) continues to provide Primary healthcare services and support to Migrants, Refugees, Internally displaces people (IDPs) and Locals. During the month of March, IRC medical teams have provided over 1320 medical consultations to beneficiaries and have successfully responded to after-hour and emergency cases and have successfully provided needed referrals. The IRC continues to conduct regular visits in 11 locations. (6 in Tripoli, 4 in Misrata and 1 in Zliten).
Under IRC’s DIFD funded program, the medical team have conducted visits three days a week to Elmgarief PHC (Sunday, Thursday and Wednesday) after obtaining security clearance on a daily basis due to the location security risks and the other two days to Bab Alhuria PHC (Monday and Thursday). Visits to these facilities were not regular during the last two weeks of March due to two main reasons. The first reason was the escalating clashes near Elmgarief PHC which ceased our visits there due to security. The second reason was that Bab Alhuris PHC has become a COVID-19 operation room for local authorities and therefore all visits have been suspended. These setbacks naturally resulted in a declined number of consultations. However, regardless of the suspended visits, follow-up cases with referral requirements were able to reach the IRC through the COVs by phone and the majority was sent to public facilities.
Under IRC’s UNHCR funded program, the mobile health team continued to conduct regular visits (twice weekly) to Zawyet Aldahmani PHC at the center of Tripoli municipality. The IRC provides primary healthcare services including medical, mental health and reproductive health. Beneficiaries have also been provided with medication and cases have been successfully referred to private facility depending on resources and the patient’s medical condition. The number of beneficiaries has declined drastically due to the imposed curfew to help control COVID-19 outbreak. The International Rescue Committee (IRC) have a Medical team fixed at CDC-Gurji throughout the week to provide our medical services. Activities were suspended in CDC-Gurji for three days after officially starting on the 1st of March in order to reorganize our services with CESVI and avoid large gatherings of beneficiaries and to install hand sanitizers throughout the building.
Under IRC’s SIDA funded program, the mobile medical team continued to conduct regular visits to two locations. Twice a week to the Sikka detention center in Tripoli and three times a week to El Harat PHC in Souq Aljomaa municipality. Activities in El Harat PHC have recently been suspended as requested by DoH of Souq El Jumma due to COVID-19. The International Rescue Committee (IRC) continue to successfully responded to after-hour and weekend emergency calls and have successfully referred the required cases. IRC community health workers (CHWs) also provide awareness sessions about IPC to the beneficiaries in the detention center.
Under IRC’s EU funded program, the IRC Mentors continued to visit health facilities on a weekly basis to provide coaching and support in the first two weeks of March. In Zliten municipality, the IRC’s RH Mentor, Nurse Mentor, HMIS Mentor and Pharmacist Mentor conducted mentorship in Hei-Almohameen, Al Qusba, Algwailat, and Ezdo Al- Janobia PHCs. In Souq Al'Jooma municipality, the HMIS Mentor, Nurse Mentor, Health Promotion Mentor, Clinical Mentor, Reproductive Health Mentor, MHPSS Mentor and Pharmacist Mentor conducted activities in Arada, Alheshan, Alharat and Bab Tajoura PHCs. In the last week of the month however, closure of health facilities in the wake of COVID-19 outbreak impeded supervision activities among others. The IRC plans to scale down health facility supervision in the face of COVID-19 pandemic.
The IRC conducted DHIS2 training to 24 HMIS focal persons from 12 supported PHCs on March 10-12, 2020. 2 IRC staff working closely with the facility focal persons also attended this training aimed at improving capacity of health facilities to collect and utilize data. The details of the participants provided below:
Zliten Municipality Souq Jooma Municipality Gharyan Municipality Al Qusaba PHC (2 Alharat PHC (2) Gharian Polyclinic (2) Algwailat PHC (2) Arada Polyclinic (2) Alwasat alqwasem (2)
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Al-Mohalameen PHC (2) Bab Tajoura PHC (2) Awlad ben Yaqup (2) Ezdo Al-Janobia PHC (2) Hashan Aljanobi (2) Abu Zayan (2)
The IRC further supported training of 15 PHC staff in Misurata from March-15-17, 2020 on infection prevention and control. Participants were drawn from Kirazaz, Sidi embark, Skiarat, and Al-Jazeera PHCs.
Terre des Hommes Italia (TDH) continued its work with the Libyan children and families served under the 2019 AICS project. Two of the three children were able to travel for scheduled follow up and rehabilitation sessions in Tunis at the beginning of the month, but the third child was unable to travel due to the border closures.
Since 2019, TDH has worked with the Municipality of Zintan to build the capacity of the medical staff at the General Hospital of Zintan, and address material constraints in the hospital facilities. Procurement was finalised in March for medical equipment, but due to COVID-19 measures and restrictions delivery is currently delayed until April/May 2020.
In March 2020, TDH began preparing its response to COVID-19 in Libya. Currently, response planning is focused on preparedness and mitigation measures aligning with the growing Health Sector response. This includes recruitment for virtual health teams, training development - including telemedicine training and support, and procurement of PPE and other critical supplies. TDH also began preparing public messaging related to MHPSS concerns and issues regarding domestic violence as it works to recruit mental health workers to increase its crisis stabilisation capacity. In April 2020,TDH will continue to scale its response as resources allow and begin delivery of preparedness and mitigation activities.
UNICEF, as part of the EUTF-sponsored project in 24 municipalities, has launched the first session of a critical training, Emergency Obstetric Newborn Care (EmONC), for 19 physicians in the targeted health facilities to ensure the ability of the targeted physicians to be able to provide quality life-saving obstetric and Newborn care services and be able to train other staff to provide the same services 24/7. The training was designed to be a sustainable process through system strengthening approach, where UNICEF has sponsored the costs to ensure the participation of physicians from faraway areas, like Ghat and Murzuk, and supported Aljalaa maternity hospital training center with the tools and equipment to facilitate this training and any future trainings. The training has started on Saturday March 7th and will continue till Wednesday March 11th at Aljalaa Maternity hospital training center at Tripoli and coordinated by the director of the training center. This training has covered most of the western and southern west municipalities and the second session target the eastern and eastern south municipalities
Moreover, as part of UNICEF’s plan to bridge the gaps of experienced maternity services in the south, trainees from the south were accommodated for 4 days of clinical hands-on training at Aljalaa Maternity hospital under the
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supervision of the senior consultants, where the trainees were mentored in the delivery ward and exposed to real scenarios.
In continuation to UNICEF’s EUTF-funded project to support the implementation of District Health Information System (DHIS2) in 670 health facilities within the targeted 24 municipalities through:
• Capacity building of the staff of the targeted health facilities on the DHIS software. • Providing the HIS focal points with required equipment. • Sponsoring the technical support for 2 years by HISP India (an international service expert). • Sponsoring the capacity building of the DHIS2 national core team by HISP India.
UNICEF has supported 5 more municipalities (Zwara, Subrata, Alzawia West and Alzawia South and Baniwaleed), where more 96 people were trained and equipped with the required IT equipment.
INFORMATION SOURCES:
https://www.who.int/health-cluster/countries/libya/en/ https://reliefweb.int/country/lby https://www.humanitarianresponse.info/ru/operations/libya EWARN: https://ncdc.org.ly/Ar/
CONTACT INFORMATION:
Mr Azret Kalmykov, Health Sector Coordinator, Tripoli, [email protected] Mr Diyaeddin Natuh, Focal point, Surveillance System of Attacks on Healthcare, WHO Libya, [email protected]
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